“They cannot scare me with their empty spaces Between stars – on stars where no human race is. I have it in me so much nearer home To scare myself with my own desert places.” -Robert Frost, ‘Desert Places’

Hospital emergency rooms throughout the world are filled with panic disorder sufferers. These people are convinced they are having a heart attack or that they have been struck with a potentially life-threatening illness because of the symptoms they experience.

Panic disorder is an anxiety disorder characterized by recurring severe panic attacks. It may also include significant behavioral change – such as sudden fear of driving/flying/the outdoors etc-lasting at least a month and an ongoing worry about having other attacks.

There is no single cause of panic disorder. Inheritance, biology, physical illness, certain types of medication, caffeine, marijuana, alcohol, thinking a certain way, ( called “cognitive distortions” in psychology), environment, stressful life events, life transitions and, most importantly, underlying psychological demons which are hidden from the individual’s conscious awareness are some of the causes.

So when the recently married George was first driven by his brother to my office (he had developed a sudden fear of driving and the outdoors) because he had experienced a series of panic attacks starting on his wedding day, I suspected that more than biology was involved. The trigger for the panic attacks seemed to be connected to his new life transition as a married man.

In treatment, I discovered that George was raised in an overly protective family environment. Albeit his parents were well-intended, their attitude was not conducive for George to individuate and gain emotional independence from them. His few attempts at making his own decisions in his teen years and later gaining emotional independence were met with castigation and stonewalling by his parents. Thus, I concluded that his panic began as a stress symptom linked to the fear and guilt of his symbiotic relationship to his parents.

Underlying his actions, George is hearing in his subconscious the parental call: “Come back to me. You’ll panic in your life.. You’ll have fear of sexuality, fear of separation from me and of being autonomous. You will feel anxious if you do anything that separates you from mother or father.” Basically, George is afraid to grow up. George has no insight into his unconscious.

I have referred him to a psychiatrist for anti-anxiety medication to ameliorate the physical symptoms of his panic. However, the jury is still out on whether George will stay in psychotherapy for the long haul, to face his underlying demons responsible for his panic. (George consented to the writing of this column. His name was changed to conceal his identity).